Everything You Need To Know About Ozempic

It wouldn’t be an understatement to call 2024 the Year of Ozempic. Semaglutide medications by Novo Nordisk—sold under the brand names Ozempic, Wegovy and Rybelsus—have dominated the news cycle. Celebrities from Whoopi Goldberg to the Osbournes have sung semaglutide’s praises, while gossip rags have made a mission of identifying who is on the drug. Earlier this year, Oprah even dedicated an hour-long TV special to semaglutides in an attempt to smash the stigma around the weight loss medication, which she purportedly uses herself. Ozempic’s popularity has spurred black market knock-offs and nationwide inventory shortages. Even food manufacturers like Nestlé are jumping on the bandwagon, offering a new line of high-fibre and -protein products to appeal to those using weight loss medications.

But how do these drugs work, what are their side effects and how do you know if they are right for you? Read on for a zero-judgment, science-based guide to semaglutide drugs.

What are semaglutide medications and how do they make you lose weight?

While Ozempic actually began as a revolutionary treatment for type 2 diabetes, semaglutide drugs often come with a side effect of weight loss.

Semaglutide is a glucagon-like peptide 1—perhaps you’ve heard of it as its acronym, GLP-1. That’s a fancy way of saying it’s a hormone, which is naturally produced in the gut in response to food intake. GLP-1 signals to the brain that it’s full, slows stomach emptying and increases insulin production. When this hormone is produced naturally, it is short-acting. Semaglutide medications, however, stay in the body longer and have a greater impact. 

“When taking semaglutide, patients usually describe being satisfied with smaller portions and being full for longer. Some people also report fewer food cravings,” explains Dr. Heidi Dutton, an endocrinologist at The Ottawa Hospital in the Division of Endocrinology & Metabolism and an assistant professor at the University of Ottawa. (Dutton has been working with semaglutide medications since 2018 when they were approved in Canada to treat type 2 diabetes.) 

How does Ozempic treat diabetes?

Ozempic has seen significant success in treating those with type 2 diabetes by decreasing insulin resistance as well as moderating blood glucose levels and hemoglobin A1C (HbA1c). 

Dutton has seen this firsthand in her practice. “Some of my patients with type 2 diabetes have been able to stop, or significantly reduce, their insulin doses,” she says. “If it’s well tolerated, semaglutide is preferable to using insulin because it doesn’t cause low blood sugars, and we also know that insulin use may promote weight gain.”

In a 2023 Frontiers in Endocrinology study, researchers found an HbA1c reduction of up to 1.8 percent and an average weight loss of 6.5 kg (about 14 pounds) among semaglutide users over a 12-month period. There was also evidence of a 26 percent reduction in risk for major cardiovascular events in type 2 diabetics.

Due to the popularity of Ozempic being prescribed off-label as a weight loss drug, it became difficult in 2023 for diabetics to access it in Canada. “Luckily, the shortages now seem to be resolved and we also have Wegovy in Canada, so semaglutide can now be prescribed on-label according to what we are using it for,” says Dutton.

“We believe the semaglutide molecule represents a significant scientific advancement that has—and will—help many people reach their treatment goals,” writes Jaclyn Crawford, associate director of communications at Novo Nordisk in an email to Chatelaine. 

While the weekly injection comes with a hefty price tag, the efficacy of semaglutide is established by research, so coverage in Canada is relatively comprehensive. Ozempic is available through most private insurance plans, writes Crawford.

How do semaglutide drugs work for weight management?

“Semaglutide is the most effective agent we have so far for weight loss,” says Dutton. “In patients who don’t have diabetes, the average weight loss seen with this drug is about 10 to 13 percent of total body weight.” Compare that to older weight loss medications—such as liraglutide and bupropion/naltrexone—which typically see an average of six to eight percent total weight loss.

Semaglutide is recommended for individuals with a BMI of 30, or 27 if they have metabolic factors—high blood pressure, elevated blood sugars, insulin resistance, excess weight around the stomach—that increase their risk of stroke and heart disease. (It’s important to note that BMI, or body mass index, has been widely discredited as a measure of health by institutions like Harvard Public Health, Yale Medicine and the British Journal of General Practice. While it is intended to measure “excess weight,” it fails to distinguish between body fat, bone mass, musculature and the distribution of fat—all factors that contribute to metabolic disorders, heart disease and type 2 diabetes.)

In a 2022 study published in Clinical Pharmacology, 86 percent of participants lost at least five percent of their total body weight using weekly subcutaneous injections for 68 weeks. Participants noted improvements in waist circumference, body mass index, blood pressure, HbA1c, fasting plasma glucose and progress in lipid profiles after 20 weeks of treatment.

But Dutton says that not everyone who meets this BMI criteria will benefit from semaglutide. “We know that many external factors contribute to an individual’s weight that may be beyond their control—genetics, social and economic factors, and use of certain medications that promote weight gain,” she says. 

“I approach [patient] challenges with excess weight the same way I would approach type 2 diabetes or high blood pressure,” Dutton adds. “We use lifestyle changes where possible but add on evidence-based medications where necessary and appropriate to optimize health. In my weight management practice, I try to maintain more of a focus on overall health and health behaviour goals rather than the number on the scale in my discussions with patients.” 

Dutton also notes the importance of destigmatizing semaglutide use for weight loss. “I want to emphasize that obesity is a chronic disease that is worthy of treatment, just like type 2 diabetes,” she says. “Patients living with either condition deserve access to effective therapies.”

How do I know which semaglutide medication is right for me?

That depends on your health goals. Semaglutides are exclusively produced by the pharmaceutical company Novo Nordisk. Health Canada has approved Ozempic, a weekly injection, and Rybelsus, an oral medication, for the treatment of type 2 diabetes. Wegovy, a weekly injection, is the only semaglutide treatment approved for obesity and weight management in the country. However, Ozempic has been widely prescribed off-label for non-diabetics considered to be obese. 

Angela Marchese, 40, lives in Hamilton, Ont., and is taking Ozempic for weight loss. “I had gained 40 lbs in one year due to a side effect of another medication,” she says. “No matter what I changed [with my] eating, I couldn’t seem to lose any weight.” (Marchese did not ask her doctor why they recommended Ozempic over Wegovy even though she did not have diabetes.)

Marchese says her experience with Ozempic so far has been positive: “I’ve lost 20 pounds [in three months]. I was expecting more weight loss but it hasn’t happened yet,” she says. In fact, the biggest issue for Marchese has not been physical side effects but rather the cost of the medication: She pays out of pocket for Ozempic—up to $300 a month—and intends to stop using semaglutides once she reaches her goal weight.

What other areas of health are improved by using semaglutide drugs?

Studies have shown health benefits beyond weight loss in patients who do not have diabetes. Dutton points to a major clinical trial from 2023 in the New England Journal of Medicine, which found that non-diabetic patients who had a history of heart disease and were using semaglutide for weight management had significantly fewer heart attacks, strokes and death from cardiovascular disease compared to the placebo group.

There has also been a lot of media attention surrounding semaglutide and Polycystic Ovary Syndrome (PCOS). One 2023 study in the Journal of Clinical Medicine found that treatment with semaglutide, at low doses, significantly reduced body weight in almost 80 percent of obese PCOS patients who were unresponsive to a previous lifestyle plan and more regulated menstrual cycles. 

There have been media claims that semaglutide can increase fertility, coining births in those struggling with conception as “Ozempic babies”; however, these claims haven’t been studied or proven in clinical trials.

How has the proliferation of Ozempic affected how we view fatness? 

Most people had never heard of Ozempic during the years it was used solely for diabetes. But the drug became increasingly stigmatized once it was used for weight loss. 

“I wish we could remove the weight bias from the narrative about semaglutide and weight loss medications in general,” says Dutton, “but once it began to be used for weight loss, suddenly we were seeing it mentioned everywhere. And there was often a negative undertone in the way this was reported on and discussed.”

Susan Lee, 61, from Owen Sound, Ont., has struggled with weight her whole life. She made strides with gastric bypass surgery, losing 250 lbs, but struggled to keep the weight off. “I’ve been a [type 2] diabetic since my 40s,” she says. “After my gastric sleeve, they stopped all my diabetic medications. That’s when the weight started to come back.” 

Lee’s doctors recommended she try Ozempic. After a year on the drug, she never lost any weight, though it did help lower her blood glucose levels. Her health also took a turn while using Ozempic: she had surgery to remove her gallbladder, part of her intestine and bladder after a bowel obstruction became septic. “I had an open drain in my abdomen for 11 weeks before they could operate. I’ve had problems ever since,” Lee says. “I don’t have the energy to exercise anymore and my stomach is in constant pain.” 

Lee doesn’t blame Ozempic solely for her near-deadly health crisis but feels strongly it was a contributing factor, along with weight stigma. Despite telling healthcare providers about her worsening Crohn’s disease and gallbladder attacks, she was kept on Ozempic, which she believes led to the bowel obstruction. “Doctors are dismissive of me since I’ve gained weight—like I didn’t try hard enough. Just last week an orthopedic surgeon asked if I’ve ever considered gastric bypass. Did he even look at my chart? I was there for a knee consultation, not a weight loss lecture.” 

Representatives Ary Maharaj and Emily Donahue at the National Eating Disorder Information Centre (NEDIC) say they’ve seen a sharp increase in individuals contacting their toll-free helpline and live chat services regarding Ozempic, with many sharing amplified feelings of shame and guilt about their bodies and weight. 

“Weight stigma exacerbates disordered eating,” Maharaj says. “This isn’t a medication problem but a societal one. Someone with an eating disorder may be tempted to use Ozempic to suppress appetite, compensate for binge eating or manage fear of weight gain. This can be particularly true for folks in larger bodies who experience discrimination and oppression at various levels due to body size.”

Unfortunately, this pressure isn’t coming solely from the media; Maharaj notes that primary care providers and even family members are recommending Ozempic, regardless of whether the individual grapples with disordered eating. The fear of the weight returning after semaglutide can trigger disordered eating behaviours such as restrictive eating, calorie counting and binge eating. 

To support loved ones affected by weight bias and disordered eating, NEDIC recommends having discussions beyond weight that explore all aspects of health—physical, mental, social and societal. “Acknowledge that people living in larger bodies face continual discrimination; discuss societal pressures that can contribute to body dissatisfaction and the harmful impacts of weight discrimination that may be driving the desire to lose weight.”

How safe are semaglutide medications? What are the side effects?

Side effects of semaglutide can range from mild to severe. The most common side effects are gastrointestinal, including nausea, vomiting, abdominal pain, diarrhea and constipation. “It’s important to have close follow-up [with your doctor] after starting the drug to monitor for any side effects and help manage them if they occur,” says Dutton. “Sometimes we need to troubleshoot the dose as some patients are not able to tolerate the higher doses. Some patients will need to stop the medication completely due to side effects.”

Serious side effects are more severe and can even be life-threatening. They include chronic or acute pancreatitis, gallbladder disorders, acute kidney injury, severe allergic reactions, and gastroparesis, a functional disorder involving the paralysis of muscles and nerves in the stomach. Diabetics also taking insulin need to monitor closely for hypoglycemia, especially when starting Ozempic. 

To help manage Ozempic side effects, ask your doctor about starting with a lower dose and gradually increasing it, says Dutton. Avoid high-fat, processed foods; instead, opt for bland, hydrating foods and consume smaller, more frequent meals. 

What about Ozempic Face?

Rapid weight loss can result in loose, sagging or aging skin, especially in the face and buttocks. Genetic and lifestyle factors affect elasticity in general; however, those who lose weight quickly may make it harder for the skin to absorb the new shape of the tissue underneath it. When people refer to “Ozempic Face,” they’re referring to the skin no longer being taut, which can have an aging effect.

How do you identify an Ozempic scam or dupe?

Scams tied to Ozempic and other weight-loss drugs are surging due to their cost and popularity. People can protect themselves by only obtaining semaglutide from a medical professional. A new report by McAfee found 176,871 phishing emails and 449 malicious websites tied to offers of Ozempic, Wegovy and semaglutide. 

Novo Nordisk is aware of knock-off medications and how celebrity trends have affected how people view Ozempic and semaglutide medications. They stress that “none of these medicines, including Wegovy, should be used for cosmetic weight loss. No Health Canada-approved generic versions of semaglutide currently exist.”

What about Mounjaro, Trulicity, Zepbound? Are they semaglutides?

Semaglutide is the newest, and potentially most effective, drug in this category. But several other GLP-1 receptor agonists are available in Canada. Liraglutide, also from Novo Nordisk, is approved for weight loss under the brand Saxenda and for type 2 diabetes as Victoza. Dulaglutide from Eli Lilly, under the brand name Trulicity, is only approved for type 2 diabetes. 

“In general, semaglutide has better blood sugar-lowering benefits than the others,” says Dutton. “We also typically see more weight loss with semaglutide compared to liraglutide in patients who do not have diabetes. All three drugs have evidence of cardiovascular benefit in patients who have type 2 diabetes. Some patients may have side effects with one GLP-1 receptor agonist but tolerate a different one without issue.”

A new GLP-1 formula may create some friendly competition in the drug category: Tirzepatide drugs, sold under brand names Mounjaro and Zepbound by Eli Lilly, are making their debut in Canada with a splash. The key difference between these drugs and other GLP-1 drugs on the market is that they also act on gastric inhibitory polypeptide (GIP) receptors, which help regulate weight and the breakdown of glucose. A 2024 study published in JAMA Internal Medicine shows a significantly higher percentage of weight loss on tirzepatide than semaglutide—but more research is needed to say for certain whether tirzepatide is more effective than semaglutide.

What happens when you stop taking Ozempic? 

Ozempic must be taken for life to maintain weight loss, notes Dutton. People who cease taking it will likely regain weight, and type 2 diabetics may need to increase medications or insulin to regulate their glucose levels.

“We know from clinical trials that when these medications are stopped, most patients will begin to regain the weight lost with these medications, and I certainly see this in my practice,” she says. “If a patient needs or wants to stop the medication, I recommend discussing this with your prescriber to make a plan.” Increasing physical activity and working with a registered dietitian on a healthy eating plan may help offset weight gain.